CONTRACEPTIVE

METHODS.
 OBJECTIVES
Aims of contraception
Ideal contraceptive.
Contraceptive methods in females.
Spacing methods
Terminal methods
Pregnancy vaccines.
Contraceptive methods in males.
Spacing methods.
Terminal methods.
Miscellaneous methods.

Thursday, May 21, 2015

 Introduction.
DEFINITION :-
Prevention Of Pregnancy.
AIMS:-
Family Planning
Prevents STD’S –AIDS.
Medical Grounds –To control stress of
pregnancy, labour & lactation.
The characteristics of an ideal
contraceptive are listed below:
Highly effective. Widespread
No side effects. availability.
Independent of Acceptable to all
intercourse. cultures and religions.
Rapidly reversible. Administration and
Cheap. healthcare
personnel not
required.
Easily distributed.

Thursday, May 21, 2015

CONTRACEPTIVEMETHODSIN
FEMALES
Spacing methods
Terminal methods
Pregnancy vaccines.
 SPACINGMETHODS.
Rhythm Methods.
Barrier Methods.
Chemical Methods.
Intrauterine contraceptive devices.
 Rhythm Methods.
Calender method / safe period method /
natural method.
Depend on time of ovulation.
Dangerous period –ovulation occurs on 14 day &
ovum viable for 48-72 hrs & sperm remain alive
for 24-48 hrs. so pregnancy occurs if coitus occur
in this period.

Thursday, May 21, 2015

 Rhythm Methods.
Safe period –rest of cycle i.e. 5-6 days after
mensturation & 5-6 days before next cycle.
Advantage –most natural
Disadvantage –most unreliable when cycle
are irregular & ovulation time is variable.

Thursday, May 21, 2015

 Barrier Methods.
Mechanical .
Diaphargm. –
Flexible rim made up of spring.
Cup shaped synthetic rubber
or plastic.
Inserted into vagina over the
cervix.
Cervical caps.
Smaller than Diaphargm,
Applied on cervix itself.
Thursday, May 21, 2015
 Mechanical
Advantages.
Inexpensive.
Do not require medical consultation.
Disadvantages.
Demonstration by trained person needed for proper
use.
Failure most common –due to displacement of
device.
Cervicitis ( inflammation of cervix) & local irritation.
Thursday, May 21, 2015
 Chemical
Spermicidal agents.– Advantages –
destroy sperms. inexpensive, well
Ricinoleic acid tolerated, provide good
protection.
Nanoxynol-9.
Octoxynol-3. Disadvantages –
messiness, local irritation
Available in different forms–
& burning sensation.
foam tablet, pastes, creams,
jellies & vaginal sponge Combined
( TODAY --Polyurethane sponge
imprignated with nanoxynol-
9.)
Thursday, May 21, 2015
 Chemical Methods.
Locally applied chemicals –anti-
spermicidal.
Foams, jellies.
Drugs –
Steroidal –
Oral contraceptives and depot preparation.
Non-steroidal --
 Steroidal
ORALCONTRACEPTIVEPILLS(OCP)
Recommended in women of younger age group
( up to 35 yrs )
Mechanism of action.
Synthetic preparation of estrogen & Progesterone.
When taken orally, hormone level rises
Negative feedback effect act on Anterior pituitary
Inhibit Gonadotrophins (FSH & LH)
Inhibit Ovulation.

Thursday, May 21, 2015

 Types.
Combined pill.
Sequential pill.
Minipill pill.
Postcoital (Morning
After) pill.

Thursday, May 21, 2015

 Combined pill.
Contains both
Oestrogen (ethyl
estradiol/mestranol) 20-
50 Mg.
Progesterone(norethister
one, norgestrel) 0.5-2mg.
Availability
MALA-N (21 Tab) &
MALA-D (28 Tab-7 ferrous
fumarate)

Thursday, May 21, 2015

 Combined pill.
Dosage – Mechanism of action.
Everyday orally at night Prevents Ovulation.
for 21 days. ( from 5thday Prevents Implantation.
to 25thday of cycle) Makes cervical
7 day break forMALA-N secretions thick & viscid
During this bleeding & prevent entry of
occurs, which is not sperm in female genital
menstrual bleeding but tract.
is withdrawal bleeding.

Thursday, May 21, 2015

Sequential pill Mini-pill.
High dose of estrogen Micro-pill.
with moderate dose of Only progesterone.
progesterone. Dose –daily through whole
Dose –oestrogen 5th- to of menstrual cycle.
15th day, then both Action –ovulation not
oestrogen+progesterone inhibited but prevents
for 5 days. fertility.
Makes cervical mucosa
High incidence of thick & decrease motility of
endometrial carcinoma so fallopian tube.
not used.
Thursday, May 21, 2015
 POSTCOITAL
Within 72 hrs of
unprotected intercourse.
Dose –2 combined pills
immediately followed by
2 pill after12 hrs.
Indication –only in
emergency– rape,
contraceptive failure, or
unprotected sex.
Thursday, May 21, 2015
Mechanism of action.
Prevents fertilization &
implantation by
hypermotility of
fallopian tube & uterus.
If ovulation &
fertilization occurred
then it prevents
implantation of
blastocyst.
 OCP
Advantages– 100 % Contra-indications.
effectivity Women having
Dis-Advantages. – carcinoma of breast &
uterus.
Hypertension.
Liver diseases
Thromboembolism.
Hyperlipidemia.
Metabolic effects –
diabetes & obesity. Age group above 35 yrs.
Carcinogenic effect –
breast & cervix.

Thursday, May 21, 2015

 Depot preparation.
Injectable
Oily solutions given Combined –
intramuscularly. Both estrogen &
Progestrin – progesterone
IM , monthly .
Medroxyprogesterone
acetate (DMPA) –IM every
3-6 months, 150-400mg. MOA–
Norethindrone enanthate Prevent ovulation &
alter cervical mucosal
(NET-EN) –IM every 3 secretions.
months , 200 mg.

Thursday, May 21, 2015

 Sub-dermal implants
Types –
Norplant –6 flexible
silastic (silicon) tubes
35 mg progesterone.
Norplant 2 –2 rods of
levonorgesterol
Location –beneath skin
of arm or forearm.
Contraception –5-6 yrs.
Thursday, May 21, 2015
 vaginal rings.
Contains norgestrel. Advantages –
Progesterone No daily intake
absorbed through Long lasting.
vaginal mucosa. Dis-Advantages –
Leads to sterility.
Alterations in
menstrual bleeding
pattern.

Thursday, May 21, 2015

 Non-steroidal contraceptives
Centchroman. Mechanism of action
Developed by Central Suppress corpus luteal
Drug Research Institute function.
(CDRI) Interfere with motility
Trade name –Saheli of fallopian tube
Dose –30mg Advantages.
twice/week for 12 Menstrual cycle remains
weeks followed by once normal.
in a week.
Complete reversibility
after withdrawal..

Thursday, May 21, 2015

 Intrauterine contraceptive
device (IUCD)
Ideal candidate. Mechanism of action.
Has born one child. Prevents implantation & growth
Normal menstrual of ovum.
cycle. By aseptic inflammation & causing
endometrium not suitable for
No pelvic implantation.
inflammation. Sperm phagocytization –by
Ready to check the neutrophils & macrophages.
device. Cu affects enzymes, motility
Makes cervical mucus thick
prevent entry of sperm.

Thursday, May 21, 2015

 Intrauterine contraceptive device
(IUCD)
Types.
Non-medicated.
Medicated.
1 generation IUCD.
ST
2ndgeneration Cu made
Lippes Loop- serpentine 2 types.
or S shaped. Cu T
Made up of Plastic. Cu T 200
Newer like NOVA-7, NOVA-T
3rdgeneration.
Hormone releasing containing
progesterone reservoir
release continuously for 1 yr.

Thursday, May 21, 2015

Cu–T.
Most commonly used .
Made up of Cu.
‘T’ shaped attached
with a nylon thread.
(tail)

Thursday, May 21, 2015

 Method of insertion.
Withdrawl method.
Ideal time –during
mensturation or
within 10 days. ( As
cervical cavity
diameter is more)
Also during 1st after
delivery.

Thursday, May 21, 2015

 Disadvantages.
IUCD May cause heavy bleeding.
May come out accidently.
Advantages. Risk of ectopic pregnancy.
Safe
Effective Contraindications.
Reversible Suspected pregnancy.
Easily pulled out when Pelvic inflammation.
not required. Heavy bleeding during
Long term mensturation.
contraception without Suffering from carcinoma
adverse effect. cervix.

Thursday, May 21, 2015

 Terminal methods.
Permanent method.
Indication.
When family is
complete.
Medical grounds.

Thursday, May 21, 2015

 Terminal
methods.
Surgical methods.
Tubectomy.
Fallopian tubes identified ,
cut , cut ends ligated &
buried.
Laparoscopic occlusion.
Tubes occluded using silicon
rubber bands, rings or clips
Method –quicker, simple, no
hospitalization.

Thursday, May 21, 2015

 MEDICALTERMINATIONOF
PREGNANCY.
Medical termination of pregnancy or MTP or
abortion is allowed under MTP act 1971.

Criteria.
Person who can do MTP
Place where it should be performed.

Thursday, May 21, 2015

 MEDICALTERMINATIONOF
PREGNANCY.
Indications.
Medicals –continuation of pregnancy is hazardous
to the mother.
Eugenic –substantial risk to the child if born.
Humanitarian ground.– when pregnancy is result
of rape.
Failure of contraceptive methods.

Thursday, May 21, 2015

 MEDICALTERMINATIONOF
PREGNANCY.
Methods –
Dilatation & curettage (D & C).
Cervix dilated with dilator & implanted ovum removed
by curettage of the endometrium.
Vacuum aspiration. (up to 12 weeks)
Same cervix is dilated & contents are aspirated by
vacuum / suction.
Administration of prostaglandins.
Prostaglandins are administered intravaginally
Causes uterine contractions –expulsion of product of
conception.

Thursday, May 21, 2015

Thursday, May 21, 2015
 Pregnancy vaccines.
Under experimental trials.
2 types.
Active immunization.
Β subunits of HCG – antibodies against beta
HCG destroy HCG produced by
syncytiotrophoblast.
Tetanus toxoid – increases antigenecity
capacity.
Vaccine against Zona Pellucida proteins

Thursday, May 21, 2015

CONTRACEPTIVE METHODS
INMALES
 Methods
Spacing methods.
Natural.
Barrier.
Chemical.
Terminal methods.
Miscellaneous methods.

Thursday, May 21, 2015

 Spacing Methods
Natural Method ( Coitus Interruptus)
Oldest method of voluntary fertility.
Male withdraws penis before ejaculation into
vagina.
Failure rate –high
As precoital secretions may contain sperm & even a
drop is enough to cause fertilization.
Wrong Timing of Withdrawl

Thursday, May 21, 2015

Barrier method–
Condom
Most widely used.
Made up of fine latex sheath.
Instructions –
Should be worn on erect penis
before intercourse. NIRODH
Air must be expelled
Held carefully when
withdrawing from vagina.
A new condom should be used
for each sexual act.

Thursday, May 21, 2015

 Barrier method
Mechanism of action,
Prevents deposition of semen into vagina.
Advantages –
Easily available , safe, inexpensive
Use dose not require medical supervision.
Provide protection against STD.
Dis-advantage
May slip off or tear off.
Interfere with sexual sensation.

Thursday, May 21, 2015

 Chemical method.
Antispermatogenic Drugs –inhibit
spermatogenesis.
1. Male pill (Gossypol)
2 Hormonal preparation
-- Testosterone
-- Testosterone with Danazol
-- Cyproterone acetate
3 calcium channel blocker--
Nifedipine
 Male pill ( Gossypol)
Composition –
Gossypol, phenolic
derivatives of
cottonseed oil.
Dose –orally.
200mg/D.– 2 months
followed by 60mg/wk.
Thursday, May 21, 2015
Mechanism of action –
exact action not known.
Causes azoospermia.
Advantages –neither
hormone nor antihormonal
activity
No change in libido &
potency.
Disadvantages –
permanent azospermic
after 6 months
 Hormonal preparation
Testosterone Testosterone with
400 mg orally causes Danazol.
azospermia. Cyproterone acetate.
Related to progesterone.
Potent anti-androgenic
agent.
Causes oligozoospermia &
loss of libido.

Thursday, May 21, 2015

 Calcium channel blockers.
Block Ca channel on cell membrane of sperm.
Prevents Ca influx –membrane becomes
rigid & loaded with cholesterol.
Rigid membrane prevents its binding to Zona
Pellucida.
So patient on Ca channel blockers
(Nifedipine) for hypertension becomes
sterile.
Thursday, May 21, 2015
 Terminal methods.
Vasectomy
Vas Occlusion with No-scalpel
technique
1. Elastomeric Plugs
2 SHUG
3 RISHUG
 Vasectomy
One cm vas deference
removed after clamping.
Both ends ligated &
sutured.
Mechanism of action –
entry of sperm into
semen prevented.
Sperm production &
hormones not affected.

Thursday, May 21, 2015

 Vasectomy
Post-operative Advantages.—
instructions –use Simple, fast, less
contraceptive expensive & no
measures (condom) as hospitalization.
he is not sterile ,after Disadvantages.
30 ejaculations semen Failure rate -0.15%
is free from sperm. Spontaneous
recalalization.
Autoimmune response.

Thursday, May 21, 2015

 Noscalpel vas occlusion.
Newer technique. Methods
Safe, convenient & Elastomer plugs.
acceptable MEDICAL GRADE
POLYURETHANE (MPU)
Principle – Elastomer MEDICAL GRADE
injected get hardened SILICON RUBBER(MSR)
insitu within 20 min & SHUG– preformed
occlude it. silicon plug used.
RISUG – reversible
inhibition of sperm
under guidance.

Thursday, May 21, 2015

 Miscellaneous methods.
Hot baths.
Hot bath (460 for few weeks.)
Suspensories.
It holds testes close to the body.
Insulated scrotal sack

Thursday, May 21, 2015

THANK YOU